Effect on milk production

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Fenugreek (Trigonella foenum-graecum L.) appears to be the herb that is most often used to increase milk supply. It has been reported to be an excellent galactagogue for some mothers, and has been used as such for centuries. The few studies that have been done have had mixed results [Swafford 2000, Reeder 2011, Turkyılmaz 2011] . Keep in mind that in almost all cases, non-pharmaceutical methods of increasing milk supply should be tried first, as there can be significant side effects from both herbal remedies and prescription medications used to increase milk supply. See the Academy of Breastfeeding Medicine’s protocol #9 on the use of galactogogues.

Mothers generally notice an increase in production 24-72 hours after starting the herb, but it can take two weeks for others to see a change. Some mothers do not see a change in milk production when taking fenugreek.

Dosages of less than 3500 mg per DAY have been reported to produce no effect in many women. One way reported to determine if you’re taking the correct dosage is to slowly increase the amount of fenugreek until your sweat and urine begin to smell like maple syrup. If you’re having problems with any side effects, discontinue use and consider alternative methods of increasing milk supply.

Fenugreek has been used either short-term to boost milk supply or long-term to augment supply and/or pumping yields. There are no studies indicating problems with long-term usage. Per Kathleen Huggins “Most mothers have found that the herb can be discontinued once milk production is stimulated to an appropriate level. Adequate production is usually maintained as long as sufficient breast stimulation and emptying continues” [Huggins].

Safety

Fenugreek is used to flavor artificial maple syrup, and is used as a common food ingredient (curries, chutneys, etc.) and traditional medicine in many parts of the world, including India, Greece, China, north Africa and the Middle East. It is a basic ingredient of curry powder (often used in Indian cooking) and the Five Spice mixtures (used in Asian cooking). It is also eaten as a salad and sprouted.

Fenugreek is considered safe for nursing moms when used in moderation and is on the U.S. Food and Drug Administration’s GRAS list (Generally Recognized As Safe). As with most medications and herbs, various side effects have been noted; see the side effects and safety information below.

Per Hale [Hale 2012], “The transfer of fenugreek into milk is unknown, untoward effects have only rarely been reported.” Hale classifies it in Lactation Risk Category L3 (moderately safe).

Ingestion of fenugreek seeds or tea in infants or late-term pregnant women can lead to false diagnosis of maple syrup urine disease in the infant due to presence of sotolone in the urine. See [Korman 2001] and other studies on fenugreek and maple syrup urine smell.

Use with caution or avoid if you have a history of:

Peanut or chickpea allergy: Fenugreek is in the same family with peanuts and chickpeas, and may cause an allergic reaction in moms who are allergic to these things. Two cases of fenugreek allergy have been reported in the literature. [Patil 1997, Ohnuma 1998, Lawrence 1999]

Diabetes or hypoglycemia: Fenugreek reduces blood glucose levels, and in the few studies using it as a hypoglycemic, also reduces blood cholesterol. Dosages higher than the recommended one (given above) may result in hypoglycemia in some mothers [Heller]. If you’re diabetic (IDDM), use fenugreek only if you have good control of your blood glucose levels. While taking this, closely monitor your fasting levels and post-prandial (after meals) levels. Mothers with hypoglycemia should also use fenugreek with caution. For more on fenugreek and glucose levels, see the references below.

Asthma: Fenugreek is often cited as a natural remedy for asthma. However, inhalation of the powder can cause asthma and allergic symptoms. Some mothers have reported that it worsened their asthma symptoms. [Dugue 1993, Huggins, Lawrence 1999].

Drug interactions

Oral drugs or herbs taken at the same time as fenugreek may have delayed absorption due to the mucilage content of fenugreek. [Wichtl 1994]

Glipizide and other antidiabetic drugs
Fenugreek reduces blood glucose levels and may enhance the effects of these drugs.

Heparin, Warfarin and other anticoagulantsTiclopidine and other platelet inhibitors
The fenugreek plant contains several coumarin compounds. Although studies have not shown any problems, it potentially could cause bleeding if combined with these types of drugs.

MAOIs
Fenugreek contains amine and has the potential to augment the effect of these drugs.

Fenugreek use during pregnancy

Medicinal doses of fenugreek (not the amounts used in curries) are considered a uterine stimulant. Fenugreek has been used to aid and induce labor [Dehlvi, Bingel 1991] and is considered to be an emmenagogue [Turner]. For this reason, fenugreek use is not recommended during pregnancy (particularly late pregnancy).

Fenugreek is used as a morning sickness remedy in Chinese medicine. [Richmond]

“Use only in moderation during pregnancy. A uterine stimulant in high doses, but quite safe as a culinary herb or during labour.” [Ody 1999]

Motherlove Herbal lists fenugreek as a cleansing herb which is “too strong or irritating” to be used during pregnancy. [Motherlove]

One study effectively used fenugreek as a source of fiber to control blood glucose and lipid levels of pregnant diabetic women. [Madar 1987]

“A stimulant effect on the isolated uterus (guinea pig) has been reported and its use in late pregnancy may not be advisable.” [Hale 2002]

“Water and alcohol extracts of fenugreek are oxytocic. They stimulate contraction of uterine smooth muscles during the last period of pregnancy according to studies on isolated guinea pig uterus tissue.” [Willard 1991]

“Fenugreek exerts an oxytocic effect in guinea pigs. Its use in humans has not been sufficiently studied, but could potentially lead to SAB or preterm labor and prematurity secondary to its oxytocic effects. Its use in pregnancy is not recommended.” [Rice]

Possible side effects for baby

Most of the time, baby is unaffected by mom’s use of fenugreek (except that more milk may be available for baby). Sometimes baby will smell like maple syrup, too (just like mom). However, some moms have noticed that baby is fussy and/or has green, watery stools when mom is taking fenugreek and the symptoms go away when mom discontinues the fenugreek.

Fenugreek can cause GI symptoms in mom (upset stomach, diarrhea), so it’s possible for it to cause GI symptoms in baby too. Also anyone can have an allergic reaction to any herb, and fenugreek allergy, though rare, has been documented.

Another reason for these types of symptoms –and perhaps more likely than a reaction to the herb– may be that mom’s supply has increased due to the fenugreek and the symptoms are those of oversupply, where baby is getting too much foremilk. Fussiness, gas and green watery stools are classic symptoms of an overabundant milk supply.

Some things to try:

Stop the fenugreek (without switching to another herb). If you are taking fenugreek for low supply, and are having problems with oversupply when taking this herb, it may be questionable whether you needed to increase supply in the first place.If you are deliberately trying to maintain an oversupply (such as when you’re pumping part/all of the time rather than nursing directly), then you might also try the following things:

Cut back on the fenugreek dosage to see if baby’s symptoms disappear.

Take measures to remedy the oversupply (help baby get more hindmilk) by doing things such as keeping baby to only one breast for up to 2-3 hours.

Try non-pharmaceutical methods of increasing supply (this is always the first thing that should be tried), or talk to your health care provider and lactation consultant about trying a different herb. This should help if baby is reacting to the fenugreek in mom’s milk.

The main question in this instance, however, is whether the fenugreek is needed at all. Many moms feel that their supply is low when it really isn’t. See Increasing Low Milk Supply for more information.

Where to get fenugreek

Fenugreek seed capsules, tinctures and teas can be purchased in many health food stores and online. You can also buy empty gelatin capsules and bulk fenugreek seed powder to make your own capsules.

Fenugreek tea is a weak form of the herb. For the tea: use a teaspoon of whole fenugreek seeds. Steep in boiling water for 15 minutes or so.

Fenugreek sprouts are another way to eat fenugreek. Fenugreek seeds can be obtained in the bulk food section of some health food stores, or you may be able to find them at a store that specializes in Indian or other eastern foods. Soak 1-2 teaspoons of the seeds in water overnight. Pour that water off the next day (or drink it – it’s fenugreek tea) and rinse seeds with clear water. Place the seeds into a sprouter (this can be as simple as a small, clear plastic clamshell carry-out container), and place on a windowsill or table with the lid slightly ajar. Rinse with water daily. The seeds will sprout in around five days.

Fenugreek seeds for mastitis or engorgement: Steep several ounces of seeds in a cup or so of water. Let seeds cool, then mash them. Place on a clean cloth, warm, and use as a poultice or plaster on engorged or mastitic breasts to help with let-down and sore spots.

Other uses for fenugreek

Fenugreek has been used traditionally to treat diabetes, coughs, congestion, bronchitis, fever, high blood pressure, headaches/migraines, diarrhea, flatulence, anaemia, irregular menstrual cycles and arthritis, to ease labor pains and menstruation pain, and as an appetite stimulant. Fenugreek has also been used as an external poultice to control inflammation and dandruff.

[Swafford 2000] Swafford S, Berens B. Effect of fenugreek on breast milk production. ABM News and Views 2000;6(3): Annual meeting abstracts Sept 11-13, 2000Background: Fenugreek is a popular herb used in the lay population as a galactogogue though scientific research regarding efficacy has not been published.Objective: To assess the effect of fenugreek on breast milk production in exclusively breast-pumping women.Methods: Ten women kept diaries of their breast milk production for two weeks. The first week established baseline milk production. During the second week three capsules of fenugreek seed were taken three times daily. This observational study used each patient as her own control in comparing breast milk production with and without the fenugreek.Results: Average daily pump volumes for week 1 and week 2 were compared. These values were statistically analyzed using the Wilcoxon signed rank test. The average daily milk volume for week 1 was 207 ml compared to 464 for week 2. This increase was statistically significant (P=0.004)Conclusion: The use of fenugreek significantly increased volume of breastmilk produced. Further study of the herb and its effects on the lactating breast is certainly warranted. The use of fenugreek to improve lactation could offer help to women with insufficient supply.

Disclaimer: Most herbal treatments have not been thoroughly researched, particularly in regard to lactation. Herbs are drugs, and some caution is necessary. I am presenting this data as is, without any warranty of any kind, express or implied, and am not liable for its accuracy nor for any loss or damage caused by a user’s reliance on this information.

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